PREVALENCE OF HEPATITIS C INFECTION AMONG ELDER

POPULATION VISITING TO DHQ HOSPITAL NAROWAL, PUNJAB

Submitted by:
Syed Hammad Ali Hamdani

R. No: 2014-HIMP-761

Syed Ali Abdullah

R.No:2014-HIMP-757

B.S HEALTH EMERGENCY AND INTENSIVE CARE TECHNOLOGY

Submitted to:
MR. SUBHANULLAH

HAFEEZ INSTITUTE OF MEDICAL SCIENCES PESHAWAR (affiliated

with) BACHA KHAN UNIVERSITY, CHARSADA

Session 2014-18

i
DEDICATION

We dedicated this book to the Almighty God, thank you for the guidance, strength, power of
mind, protection and skills and for giving us a healthy life.

This study is wholeheartedly dedicated to our beloved parents, who have been our source of
inspiration and gave us strength when we thought of giving up, who continually provide their
moral, spiritual, emotional, and financial support.

To our brothers, sisters, relatives, mentor, friends, and classmates who shared their words of
advice and encouragement to finish this study.

Syed Hammad Ali Hamdani

Syed Ali Abdullah

ii
ACKNOWLEDGMENTS

First and foremost, we must acknowledgments and thank The Almighty ALLAH for his showers
of blessing, protecting and guiding us in completing this research thesis successfully. We could
never accomplished this without the faith I have in almighty.

We would like to express my special appreciation and thanks to my supervisor Subhan ullah for
encouraging my research and allow me to grow as a research scientist. His advice on research as
well as on my career has been priceless.

We are also thankful to Dr Muhammad Ali who helped us and encourage us in the completion
of research report.

We would like to express our deep and sincere gratitude to Dr Anwar-ud-Din chairman of
Hafeez Institute of Medical sciences Peshawar for providing us necessary facilities during our
studies and research.

We would like to thanks to all our friends Dr Azmat uzair, Dr Jawad Ahmad and Ali Raza
who supported us in writing and incanted us to strive towards my goal.

Syed Hammad Ali Hamdani

Syed Ali Abdullah

iii
ABSTRACT

BACKGROUND

Ratio of hepatitis C is very high all in over the Pakistan. We selected the area in Pakistan for our
research study is DHQ Hospital Narowal District in Punjab. In our study we find the prevalence
of Hepatitis C of the people who are visiting to DHQ hospital Narowal, Punjab, Pakistan

MATERIALS AND METHODS

We did a cross sectional research to find out the prevalence of Hepatitis C among the elder
population of District Narowal. We used Questioner to collect the data from the people who
visited to DHQ hospital Narowal between the ages 17-70 years of any gender.

RESULT

We found that, female were more effected than males with a ratio of 56.4%.Mostly the people
with HCV infection were 31-45 years old with a ratio of 42.7%. Eighty percent were positive for
HCV when they first tested. Eighty-three percent of the patients said they got blood transfusion
from infected person, while on the answering of another question we asked, nearly Sixty-three
percent of the patient got Hepatitis C infection from needles and sharp instruments.

CONCLUSION

In the DHQ hospital District Narowal, Punjab females are mostly effected and the high risk
factor is receiving blood from infected person of from contacting with needles and sharp
instruments.

iv
TABLE OF CONTENTS

CHAPTER – 1

Introduction

1.1 Hepatitis 7

1.2 Hepatitis C 7

1.3 Epidemiology 7

1.4 Classification of hepatitis C 10

1.5 Sign and symptoms 10

1.5 Pathophysiology 11

1.7 Causes and risk factor 12

1.8 Diagnosis 12

1.9 Management 14

1.2.0 Prevention 14

CHAPTER – 2

Aims and Objectives 16

CHAPTER- 3

Literature review 16

CHAPTER – 4

4.1 Study Design 20

4.2 Study Setting 20

4.3 Study Duration 20

4.4 Sample Technique 20

v
4.5 Sample size 20

4.6 Inclusion Criteria 20

4.7 Exclusion Criteria 20

4.8 Data Collection Procedure 21

4.9 Data Analysis Procedure 21

CHAPTER – 5

5.1 Result According To Objective 22

5.2 Discussion 41

CHAPTER – 6

6.1 Conclusion 43

6.2 Recommendation 43

References 43

vi
Chapter 1

INTRODUCTION

1.1 Hepatitis

Hepatitis is a condition in which our liver becomes inflamed. Mostly caused by viral infection
but it also has some other possible causes such as drugs, toxin, alcohol, an autoimmune disease.
(1) viral hepatitis has many types such as A, B, C, D, E, and G, but the most common hepatitis
viruses are A, B, and C. Reference to the hepatitis infections regularly happens in an abridged
frame (for instance, HAV, HBC, HCV speak to hepatitis infections A, B, and C, individually.)
Hepatitis viruses cause the liver to be unable to perform its function because it multiplies in liver
cells. (2)

1.2 Hepatitis C

Hepatitis C is the infection caused by hepatitis C virus (also called to as HCV). Hepatitis C virus
(HCV), which was first characterized in the late 1980s, is an RNA Flavivirus with 6 major
genotypes and more than 50 subtypes. It is hard for the immune system to remove the hepatitis c
from the body. The infection which is caused by Hepatitis C virus usually become chronic. (3)
Around 60% to 85% of people infected with hepatitis C virus will lead to developing chronic
hepatitis C, which is now believed to affect 3% of the total population in the world. (4) Hepatitis
C is highly variable from a minor change to major such as fibrosis and cirrhosis with or without
hepatocellular carcinoma. Initially HCV show no symptoms and the virus is removed by the
immune system about 25% of cases and remaining 75% can lead to chronic hepatitis. (5)  

Hepatitis C virus (HCV) infection is a blood-borne illness and a major pathological state
worldwide. This virus infects approximately 3rd of the global population, putting more or less
170 million individuals in danger of developing the HCV-related chronic disease. (6)

1.3 Epidemiology

It is estimated that 123–170 million people worldwide are living with HCV infection, of whom
250 000 (0.8%) are in Canada(7). Approximately 2.7 to 7.1 million Americans have chronic

1
hepatitis C. It's calculable that 16,000 to 75,000 deaths yearly are attributed to HCV, and a lot of
Americans die from HCV than the other infectious cause (8).

According to a report of World Health Organization (WHO), 3 % of the population within the
world and over 100 million individuals in Asia are infected with chronic HCV infection, and 23
million of them living in the eastern Mediterranean countries. The highest prevalence of the
illness was reported in Africa and also the middle east and therefore the lowest prevalence of it's
been determined within the United States of America, Australia, and Northern and Western
Europe (9).

Prevalence of HCV in Pakistan is among the highest in the world and estimated to be 4.8%.
although, 10 million people are infected with HCV in Pakistan(10). According to a recent survey
conducted by Pakistan medical and research council, the prevalence of HCV in four provinces of
Pakistan is as follows;

a. Punjab 6.7%

b. Sindh 5%

c. Balochistan 1.5%

d. Khyber-Pakhtunkhwa (Previously known as NWFP) 1.1%(11)

1.3.1 East Asia. In mainland China and Taiwan, large national seroepidemiological studies
reveal an overall antiHCV prevalence between 3 and 4% and smaller studies describe large
variances by geographical region.

Hong Kong is thought to have a relatively low prevalence of HCV, although current data may
not be representative as patients were either volunteer blood donors or healthy volunteers Japan
and Korea’s low HCV prevalence has been determined by studying millions of volunteer blood
donors and a meta-analysis of four different population-based studies respectively.(12)

1.3.2 South Asia. The prevalence of HCV in India has not been studied systematically with few
large, population based studies. Much of the work on HCV prevalence in India has been done

2
among blood donors with most finding rates below 2%. In Pakistan, Khoker et al.’s large study
of healthy adults revealed a similar HCV prevalence (5%) to those found by two separate Meta
analyses of this topic.(12)

1.3.3 HCV prevalence in children

Anti-HCV prevalence in children Anti-HCV prevalence in children (<15 years old) in the above
countries was used to estimate prevalence in children by the World Bank regions (low income,
lower middle income, upper middle income and high income). Insufficient data was available to
determine HCV prevalence by the GBD regions. The ratio of HCV prevalence in children to
adults was applied to adult HCV prevalence in countries missing prevalence among children in
each World Bank region.(13)

1.3.4 HCV prevalence in adults

Most studies reported HCV prevalence in the adult population. For the purpose of this exercise,
the definition of adults was assumed to include all individuals aged P15 years. When a study
included data in children, prevalence in adults was calculated using the reported prevalence by
age groups. In addition, when studies that calculated HCV prevalence in 2013 by age group were
available the adult prevalence from those studies was considered. Countries where adjustments
were made to capture only the adult population and/or HCV infection in 2013 included:
Australia, Bangladesh, Belgium, Brazil, Cameroon, Canada, Czech Republic, Denmark,
Ethiopia, Finland, France, Germany, Ireland, Luxembourg, New Zealand, Pakistan, Portugal,
Slovakia, Spain, Sweden, Switzerland, Thailand, Tunisia, United Kingdom and Yemen.(13)

1.3.5 Geographical distribution of HCV Genotype

Hepatitis C is divided into six different genotypes throughout the world. Each genotype has
further multiple subtypes. A genotype is a classification of a virus based on the genetic material
in the RNA (RNA is strand for Ribonucleic acid) strands of the virus. Following is a list of the
different genotypes of chronic Hepatitis C, Genotype 1a , Genotype 1b, Genotype 2a, 2b, 2c &
2d, Genotype 3a, 3b, 3c, 3d, 3e & 3f, Genotype 4a, 4b, 4c, 4d, 4e, 4f, 4g, 4h, 4i & 4j , Genotype
5a ,Genotype 6a.

3
Genotype 1 is the most common type which causes hepatitis c in the USA and it is very difficult
to remove and treat. (14) In Pakistan, Genotype 3 occurred predominantly in all provinces of
Pakistan. While Second more often genotype was genotype 1 which mostly occur in Punjab, the
province of Pakistan.(15) Most reveal that 1b is most common in China, Hong Kong and Taiwan
with 6a found in various parts of the Pearl River Delta of China and Hong Kong respectively.
(16) Genotype 3 appears to be the dominant virus in both India and Pakistan.

1.4 Classification of Hepatitis C:

Hepatitis c is classified into two types:

1- Acute viral hepatitis C

2- Chronic viral hepatitis C

1.4.1 Acute Viral Hepatitis C

Acute viral hepatitis c is a short illness that happens at intervals the primary six months once
somebody is exposed to the hepatitis C virus. For many people, acute infection results in chronic
infection.

During this acute period, symptoms will be similar to those caused by any other viral syndrome.
People with acute HCV will experience: abdominal discomfort, nausea, fever, joint pain, fatigue,
jaundice, rarely, clay-colour stools, rarely(17)

1.4.2 Chronic viral Hepatitis C

While Chronic viral hepatitis is a long-run sickness that happens when the viral hepatitis virus
remains in an exceedingly person’s body. Viral hepatitis viral infection will last a lifetime and
cause serious liver issues, as well as liver disease (scarring of the liver) or carcinoma.(18) Most
people experience no symptoms with chronic HCV infection. Some may experience ongoing
episodes of abdominal pain, persistent fatigue, and aching joints.(17)

1.5 Sign and Symptoms:

4
Most people (about 70% – 80%) with associated acute hepatitis C infection don't expertise any
symptoms or show signs of the infection. If hepatitis C symptoms do occur, they typically seem
inside period of time to 6 months once being exposed to the hepatitis C virus (HCV). Feeling
very tired, Sore muscles, Joint pain, Fever, Stomach pain, Itchy skin, Dark urine, A yellow
discoloration of the skin and whites of the eyes called jaundice (18) weight loss, depression,
anxiety over the illness, aging, sleep disturbance, or another medical condition. Other, less
frequent symptoms are nausea, poor appetite, muscle aches, arthralgia, feverishness, weakness.
Symptoms are rarely incapacitating, but they can cause a decrease in the quality of life. In
general, it's believed that patients with symptoms have the additional severe sickness than those
that are symptomless. Because the symptoms of hepatitis are nonspecific(19)

1.6 Pathophysiology

It is currently clear that HCV genotype 3 is that the only genotype responsible for virus-induced
steatosis, whereas in patients infected with different HCV genotypes the presence of this lesion is
related mainly to exogenous metabolic factors. (20) After getting into a susceptible host, HCV
invades, infects and replicates among the bloodstream, continuance the method in various
tissues, additionally as in peripheral B and T lymphocytes, because it proceeds to the liver by
reaction, passing through varied tissues like those of the duct gland, thyroid, adrenal glands,
spleen and bone marrow(21) Since HCV may directly infect the lymphoid tissue, its stimulation
will lead to the development of B-cell lymphomas. it's noted that the liver is that the principal
site of HCV replication and numerous studies have shown that this virus infects around 10 of
internal organ cells(20) To enter the host cell, HCV E2 and E1 proteins recognize and bond with
the CD81 receptors present on the surface of hepatocytes and lymphocytes. Current HCV
particles are amid low-density and extremely low-density lipoproteins, that prompts discussion
within the literature concerning the chance that LDL is additionally a viral receptor. (22) After
the interaction of the virus envelope with the host cell membrane, HCV enters the cell through
endocytosis. Within the protoplasm, the mRNA then undergoes translation, and polyproteins are
processed; the HCV RNA then replicates, after that the new viral 'RNA's are pre-packaged and
transported to the surface of the host cell so they'll distribute and complete a brand new cycle.

5
(23) The HCV multiply approximately 1 × 1012 virions per day, because its replication rate is
high.

The pathological process of HCV infection throughout pregnancy remains poorly understood.
Recent studies have incontestable there's a decrease of levels of bodily fluid alanine
aminotransferase (ALT) throughout the second and third trimesters of gestation. However, the
HCV infective agent load will increase and reaches a peak throughout the third trimester.(24)
Recent researches show HCV infection may increase the risk of preterm delivery, low birth
weight, low Apgar score, gestational diabetes, congenital malformation and overall perinatal
mortality.(24)

1.7 Causes and risk factors

The viral hepatitis virus is a blood-borne virus. Its most typically transmitted through injecting
drug use through the sharing of injection equipment the reuse or inadequate sterilization of
medical or surgical equipment, particularly syringes and needles in healthcare settings and also
the transfused through blood products unscreened blood. HCV can even be transmitted sexually
and may be passed from an infected mother to her baby but these modes of transmission are not
more common. Hepatitis C cannot be spread through breast milk to baby, food, water or by
casual contact such as kissing, foreplay and sharing food or drinks with an infected person.(25)

The Centres for Disease Control (CDC) have identified the factors that lead to the greatest risk of
HCV exposure. These include: people in the UK who received blood transfusions before
September 1991, receiving transfusions or organ transplants before 1992, using or having used
injectable drugs, haemophilia, long-term haemodialysis, exposure to a needle stick, especially for
people who work in healthcare, HIV, getting a tattoo in an unregulated setting, risky sexual
behaviours such as unprotected intercourse with an intravenous drug user, being born to a mother
with HCV infection, being incarcerated, a history of long-term daily alcohol use, unexplained
liver disease, snorting drugs.(17)

1.8 Diagnosis:

6
Hepatitis C is typically analysed utilizing two blood tests: the antibody test and the PCR test. The
outcomes generally come within two weeks.

Exposure to HCV – past, current or resolved – is determined by detection of hepatitis C antibody

(anti-HCV), most often by positive high-sensitivity enzyme immunoassay (EIA) also known as
enzyme-linked immunosorbent assay (ELISA). Subsequent generations of the EIA have
improved the sensitivity of the test and shortened the average window period prior to detectable
seroconversion, and false negatives with second-generation EIAs or later are rare.(26)

The antibody blood test decides if you have ever been presented to the hepatitis C infection by
testing for the presence of antibodies to the infection. Antibodies are created by your
invulnerable framework to battle germs. The test won't demonstrate a positive response for a few
months after infection because your body take some time to make these antibodies. If the test is
negative, however you have symptoms or you may have been presented to hepatitis C, you might
be encouraged to have the test once more. A positive test shows that you have been infected at
some stage. It doesn't really mean you are as of now infected, as you may have since cleared the
infection from your body. The best way to tell on the off chance that you are right now tainted is
to have a moment blood test, called a PCR test. (27)

The PCR blood test checks if the virus is still present by detecting whether it is reproducing
inside your body. A positive test means your body has not fought off the virus and the infection
has progressed to a long-term (chronic) stage.(28)

1.8.1 Tests for liver damage

Doctors typically use one or more of the following tests to assess liver damage in chronic
hepatitis C.

1. Magnetic resonance elastography (MRE). A non-invasive alternative to a liver biopsy

MRE combines magnetic resonance imaging technology with patterns formed by sound
waves bouncing off the liver to create a visual map showing gradients of stiffness
throughout the liver. Stiff liver tissue indicates the presence of fibrosis, or scarring of the
liver, as a result of chronic hepatitis C.

7
 2. Transient elastography. Another non-invasive test, transient elastography is a type of
ultrasound that transmits vibrations into the liver and measures the speed of their
dispersal through liver tissue to estimate its stiffness.
3. Liver biopsy. Typically done using ultrasound guidance, this test involves inserting a thin
needle through the abdominal wall to remove a small sample of liver tissue for laboratory
testing.
4. Transient elastography: A member of the care team performs transient elastography — a
painless alternative to liver biopsy — to assess liver damage.(26)

1.9 Management

There are certain types of treatments to manage the Hepatitis C infection

1.9.1 Antiviral medications

Hepatitis C infection is deal with antiviral medications, to clear the virus from your body. The
goal of treatment is to have no hepatitis C virus detected in your body at least 12 weeks after you
complete treatment.

Researchers have recently made significant advances in treatment for hepatitis C using new,
"direct-acting" anti-viral medications, sometimes in combination with existing ones. As a result,
people experience better outcomes, fewer side effects and shorter treatment times, some as short
as eight weeks. The choice of medications and length of treatment depend on the hepatitis C
genotype, presence of existing liver damage, other medical conditions and prior treatments.

Antiviral medication name

 Pegylated interferon (Peg-IFN)

 Ribavirin (RBV)
 VICTRELIS (boceprevir) and INCIVEK (telaprevir)
 OLYSIO (simeprevir)
 SOVALDI (sofosbuvir)
 HARVONI (ledipasvir/sofosbuvir)

1.9.2 Liver transplantation

8
If you have developed serious complications from chronic hepatitis C infection, liver
transplantation may be an option. During liver transplantation, the surgeon removes your
damaged liver and replaces it with a healthy liver.

1.2.0 Prevention

If you receive a diagnosis of hepatitis C, your doctor will likely recommend certain lifestyle
changes. These measures will help keep you healthy longer and protect the health of others as
well:

 Stop drinking alcohol. Alcohol speeds the progression of liver disease.

 Avoid medications that may cause liver damage. Review your medications with your
doctor, including over-the-counter medications you take as well as herbal preparations and
dietary supplements. Your doctor may recommend avoiding certain medications.

 Help prevent others from coming in contact with your blood. Cover any wounds you
have and don't share razors or toothbrushes. Don't donate blood, body organs or semen, and
advise health care workers that you have the virus.(26)

 Educate: Advocacy and raising awareness of all types of viral hepatitis infections help
reduce transmission in the community. (29)

 Safer sex practices, including minimizing the number of partners and using barrier
protective measures (condoms), protect against HBV and possibly against HCV
transmission. (29)

 Safe food and water provide protection against HAV and HEV infections. (29)

9
Chapter 2

AIMS AND OBJECTIVES

 To determine the prevalence of Hepatitis C in adults visiting to DHQ Hospital Narowal.

 To find out the most affected age group among the older population.

 To find out most affected gender of hepatitis C.

Chapter 3

LITERATURE REVIEW

Abdul Bari et al. conducted a research in “Rawalpindi-Islamabad” on a topic “Risk factors for
hepatitis C virus infection in male adults in Rawalpindi-Islamabad, Pakistan” concluded that
HCV control and prevention programs in this region should include safe injection practices and
educate men about the risk of HCV infection from contaminated instruments used by barbers.
(30)

Erin Gower et al. conducted a research in “Center for Disease Analysis, Louisville, CO, USA”
on a topic “Global epidemiology and genotype distribution of the hepatitis C virus infection”
concluded that, the total number of HCV infections reported here are lower than previous
estimates. The exclusion of data from earlier studies conducted at the peak of the HCV epidemic,
along with adjustments for reduced prevalence among children, are likely contributors. The
results highlight the need for more robust surveillance studies to quantify the HCV disease
burden more accurately. (13)

Muhammad Ghias et al. conducted a research in “Punjab, Pakistan” on a topic “Identification of

epidemiological risk factor for Hepatitis C in Punjab, Pakistan ” concluded that, results from
multiple linear logistic regression model for overall data showed that age (OR=1.035, p=0.001),
history of blood transfusion (OR=9.204, p=0.004), history of hospitalization (OR=2.979,

10
p=0.043), Tattooing (OR=27.484, p=0.013), family history of hepatitis (OR=4.069, p=0.000),
surgical operation (OR=4.290, p=0.030) were found to have significant and positively
association with Hepatitis C. Conclusion: Hence our estimated logit model can be used to predict
the chance of hepatitis C under the presence or absence of certain significant factors.(31)

Chun-Yan Yeung et al. conducted a research in “Department of Medicine, Mackay Medical

College, New Taipei City 252, Taiwan” on a topic “Vertical transmission of hepatitis C virus:
Current knowledge and perspectives” concluded that, HCV infection affects a large number of
women of reproductive age worldwide, and vertical transmission remains a serious public health
problem. The high prevalence of global HCV infection necessitates renewed efforts in primary
prevention, including vaccine development, as well as new approaches to reduce the burden of
chronic liver diseases. Based on present knowledge of perinatal transmission of HCV, all
children born to women with anti-HCV antibodies need to be tested for HCV infection. Though
universal screening is controversial, selective antenatal HCV screening on high-risk populations
is highly recommended and should be tested probably. At present, no intervention has been
clearly demonstrated to reduce the risk for HCV vertical transmission. Caesarean section should
not be recommended as a method to prevent vertical transmission of HCV, however,
breastfeeding is generally not forbidden. Awareness of HCV infection status in those high-risk
population is mandatory. Novel approaches need to be considered to improve the knowledge of
HCV trans- mission and hopefully improve HCV-associated health outcomes in high-risk
populations. Future researches should focus on the interruption of vertical transmission,
developments of HCV vaccine and direct-acting antivirals in infancy and early childhood. To
prepare a more comprehensive and concrete standard for the prevention of HCV vertical
transmission, a large scale and long-term follow-up study of children should be organized, as this
may establish the need for more aggressive measures for prevention and treatment. Eventually,
we believe that the number of new patients with HCV vertical transmission can be further
decreased in the future.(32)

Zubia Masood et al. conducted a research in “Civil Hospital, Karachi “on a topic “Screening for
Hepatitis B & C: A routine preoperative investigation” concluded that, the prevalence of HBsAg
and anti-HCV in hospitalized surgical patients is very high. There is lack of routine serological
screening in our hospitals prior to surgery. A protocol should be developed and implemented

11
whereby screening for Hepatitis B and C should be a routine pre-operative investigation. The
major risk factors include re-use of contaminated syringes, contaminated surgical instruments
and blood products.(33)

Fida Hussain Shaikh et al. conducted a research in “Larkana city, Pakistan” on a topic “Hepatitis
C: Frequency and risk factors associated with sero-positivity among adults in Larkana city”
concluded that, Total 450 cases were enrolled into this study. They were divided into 3 age
groups. Eighty-nine (19.8%) cases were in age group <20 years, 262 (58.2%) were in age group
20–40 years and 99 (22.0%) were in age group >40 years. There were 353 (78.4%) male and 97
(21.6%) female subjects, out of these 450 cases 30 (6.6%) were positive for Anti-HCV. A
number of risk factors of HCV transmission were present in these cases. History of therapeutic
injections was present in 72 cases and 35 cases used public barber services. Conclusion: History
of therapeutic injections and use of barber services for shave were the most frequent risk factors
in our study. (34)

William Sievert et al. conducted a research in “Center for Disease Analysis, Kromite, 901 Front
Street, Suite 291, Louisville, CO 80027, USA” on a topic “A systematic review of hepatitis C
virus epidemiology in Asia Australia and Egypt” concluded that, we recommend implementation
of surveillance systems to guide effective public health policy that may lead to the eventual
curtailment of the spread of this pandemic infection.(35)

L. H. Nguyen et al. conducted a research in “Stanford University School of Medicine, Stanford,

CA, USA” on a topic “Systematic review: Asian patients with chronic hepatitis C infection”
concluded that, given the high HCV endemicity in Asia, lack of identifiable risk factors and
favourable treatment response rates in Asians, we advocate the screening for HCV infection of
all Asians who come from areas where HCV prevalence is 2%.(12)

Syed Asad Ali et al. conducted a research in “Pakistan” on a topic “Hepatitis B and hepatitis C in
Pakistan: prevalence and risk factors” concluded that, Conclusions: Data suggest a moderate to
high prevalence of hepatitis B and hepatitis C in different areas of Pakistan. The published
literature on the modes of transmission of hepatitis B and hepatitis C in Pakistan implicate
contaminated needle use in medical care and drug abuse and unsafe blood and blood product
transfusion as the major causal factors.(11)

12
S. Lanini et al. concluded a research in “National Institute for Infectious Diseases-IRCCS, Rome,
Italy” on a topic “Hepatitis C: global epidemiology and strategies for control” concluded that,
with effective global scale-up of the new DAA treatment. Alongside evidence-based
interventions for primary prevention, control and elimination of HCV is a feasible goal.
Complete eradication of HCV, although desirable, is not yet in reach. Key barriers to
elimination, especially in LMICs, that must be addressed include current low implementation of
primary prevention measures. Poor characterization of local HCV epidemiology, and relatively
weak diagnostics capacity. A key challenge is how to make the treatments affordable and ensure
that they are accessible to all who need them. The demand for affordable treatment for HCV
requires comprehensive price reduction strategies for medicines and diagnostics that could
include fostering generic competition, including voluntary licences, differential pricing, and
direct price negotiations with manufacturers. The global response in HCV control can also learn
from successful public health programmes in other areas, including those for HIV and
tuberculosis. Innovative HIV service delivery approaches for marginalized and vulnerable
populations, for example, can be adapted for reaching those key populations most affected by
HCV. Effective implementation of the global hepatitis strategy will depend on effective
collaboration with partners, including multilateral and bilateral donor and development agencies,
funds and foundations, and civil society.(36)

13
Chapter 4

MATERIALS AND METHODS

4.1 Study Design:

This study was conducted through Descriptive cross sectional study, the aim of this
study, to find out the prevalence of hepatitis C among the elder population in DHQ
hospital Narowal Punjab.

4.2 Study Setting:

The current study was conducted in DHQ hospital Narowal Punjab.

4.3 Study Duration:

The duration was four months April 2018 to July 2018.

4.4 Sample Technique:

Through sample random sampling technique data was collected, directly asked the
question from patients

4.5 Sample Size:

Sample size was more than 100.

4.6 Inclusion Criteria:

 Those patients who are above 16 years of age.

 Those patients who are below 70 years of age.

4.7 Exclusion Criteria:

 Those patients who are below 16 years of age.

 Those patients who are above 70 years of age.

14
4.8 Data Collection Procedure:

Data collection procedure was according to the questionnaire. We asked question in very
easily and clearly method

4.9 Data Analysis Procedure:

Each variable is observed and each questionnaire is checked carefully. All the questionnaire are
summarized and simplify and enter into (statistical package for social science) SPSS version 20.

15
Chapter 5

Result and Discussion

5.1 Result

In which gender hepatitis C is most common?

Table 5.1

Gender

Frequency Percent Valid Percent Cumulative Percent

Male 48 43.6 43.6 43.6

Valid Female 62 56.4 56.4 100.0

Total 110 100.0 100.0

Figure 5.1

We collected a data from different patient of different age. The frequency of female is more than
males. Males are effected by 43.6% while females have a ratio of 56.4. Which shows that the
prevalence of hepatitis C is more in females

16
In which age Hepatitis C is most common?

Table 5.2

Age
Frequency Percent Valid Percent Cumulative Percent
16-30 27 24.5 24.5 24.5
31-45 47 42.7 42.7 67.3
46-60 18 16.4 16.4 83.6
61-70 12 10.9 10.9 94.5
71-80 6 5.5 5.5 100.0

Total 110 100.0 100.0

Figure 5.2

Age percentage are given in the Table, the most effective age which have high frequency of
Hepatitis C is 31-45 yrs. which is about 42.7% which is very high than other age.

17
Had you heard about Hepatitis C before?

Table 5.3
Had you heard about hepatitis C before?

Frequency Percent Valid Percent Cumulative Percent

Yes 102 92.7 92.7 92.7

No 8 7.3 7.3 100.0

Total 110 100.0 100.0

Figure 5.3

Here we asked a question about awareness of hepatitis C, 92.7% people heard about hepatitis C
and 7.3% people not heard about hepatitis C.

18
Did you see a doctor about your hepatitis C test result?

Table 5.4
Did to see your test result to doctor?

Frequency Percent Valid Percent Cumulative Percent

Yes 54 49.1 49.1 49.1

No 55 50.0 50.0 99.1

Don't know 1 .9 .9 100.0

Total 110 100.0 100.0

Figure 5.4

49.1% people did see their test result to doctor and 50.0% did not see their test result to doctor
and on another hand 00.9% did not give response.

19
Did you have other blood test to check how liver is working?

Table 5.5

Did you have other blood test to check how liver is working?

Frequency Percent Valid Percent Cumulative Percent

Yes 38 34.5 34.5 34.5

No 39 35.5 35.5 70.0

Don't know 33 30.0 30.0 100.0

Total 110 100.0 100.0

Figure 5.5

34.5% patient did their blood test to check how liver is working and 35.5% did not there blood
test to check how liver working and 30% did not give any response.

20
For how long you known about Hepatitis C?

Table 5.6
For about how long have you known about hepatitis C?

Frequency Percent Valid Percent Cumulative

Percent

Few days ago 25 22.7 22.7 22.7

Few months ago 32 29.1 29.1 51.8

Few years ago 53 48.2 48.2 100.0

Total 110 100.0 100.0

Figure 5.6

48.2% patients said they already know about Hepatitis C for few years, 29.1% said from few
months before and 22.7% said from few days before.

21
Did you have a liver biopsy?

Table 5.7
Did you have a liver biopsy?
Frequency Percent Valid Percent Cumulative
Percent
Yes 1 .9 .9 .9
No 108 98.2 98.2 99.1
Don't know 1 .9 .9 100.0

Total 110 100.0 100.0

Figure 5.7

When we asked about liver biopsy, 98.2% of peoples said No while 0.9% said don’t know and
remaining 0.9% said yes.

22
Why you were first tested for hepatitis C? Was it because

Table 5.8
Why you were first tested for hepatitis C? was it because
Frequency Percent Valid Percent Cumulative
Percent
You donated blood 15 13.6 13.6 13.6
Other reason 89 80.9 80.9 94.5
Jaundice 6 5.5 5.5 100.0

Total 110 100.0 100.0

Figure 5.8

80.9% patients said they did test for other reason, while 13.6% said they did due to blood
donation.

23
Is test result positive?

Table 5.9
Is result positive when you done the test?
Frequency Percent Valid Percent Cumulative
Percent
Yes 89 80.9 80.9 80.9
No 7 6.4 6.4 87.3
Valid
Don't know 14 12.7 12.7 100.0

Total 110 100.0 100.0

Figure 5.9

Out of 100% of patient 80.9% patient said they got positive result, while 12.7% said don’t know.

24
Did you ever received Hepatitis B vaccine?

Table 5.10

Did you ever received hepatitis B vaccine?

Frequency Percent Valid Percent Cumulative
Percent
Yes 44 40.0 40.0 40.0
No 58 52.7 52.7 92.7
Valid
Don't know 8 7.3 7.3 100.0

Total 110 100.0 100.0

Figure 5.10

Out of 100% of patients 40% patients said they received hepatitis B vaccine while 52.7%
patients said they did not get hepatitis B vaccine and 7.3 % did not give response

25
Did you received blood transfusion ever?

Table 5.11

Did you received blood transfusion ever?

Frequency Percent Valid Percent Cumulative
Percent
Yes 29 26.4 26.4 26.4
No 79 71.8 71.8 98.2
Valid
Don't know 2 1.8 1.8 100.0

Total 110 100.0 100.0

Figure 5.11

Out of 100% of patients 26.4% said they did received blood transfusion while 71.8% said no to
received blood transfusion ever and 1.8% did not give any response

26
Did you ever injected drugs not prescribed by doctor?

Table 5.12
Did you ever injected drugs not prescribed by a doctor?
Frequency Percent Valid Percent Cumulative
Percent
Yes 11 10.0 10.0 10.0
No 91 82.7 82.7 92.7
Valid
Don't know 8 7.3 7.3 100.0

Total 110 100.0 100.0

Figure 5.12

Out of 100% of a patient 10% said yes they injected drugs without doctor prescription while
82.7% said they did not injected any drugs without doctor prescription and 7.3% did not give any
response.

27
Did your doctor tell you about medication?

Table 5.13
Did your doctor tells you about hepatitis C medication such as Interferon and
Ribavirin?
Frequency Percent Valid Percent Cumulative
Percent
Yes 47 42.7 42.7 42.7
No 38 34.5 34.5 77.3
Valid
Don't know 25 22.7 22.7 100.0

Total 110 100.0 100.0

Figure 5.13

Out of 100% of patients 42.7% said their doctor tell them about their medication while 34.5%
said no and 22.7% said don’t know.

28
Did you got treated with these medications?

Table 5.14
Did you get treated with these medications?
Frequency Percent Valid Percent Cumulative
Percent
Yes 15 13.6 13.6 13.6
No 81 73.6 73.6 87.3
Valid
Don't know 14 12.7 12.7 100.0

Total 110 100.0 100.0

Figure 5.14

By asking a question about the treatment with Hepatitis C medication, 73.6% patients said they
didn’t get treated with these medications, while 13.6% of patients said they get treated with
certain medication. 12.7% of patients said we don’t know about these medication. So the ratio of
treated person with medication is very low.

29
Why did you not get treated?

Table 5.15

Why did you not get treated? was it because . . .

Frequency Percent Valid Percent Cumulative
Percent
Yours careless 19 17.3 17.3 17.3
Expensive treatment 26 23.6 23.6 40.9
Valid
Other reason 65 59.1 59.1 100.0

Total 110 100.0 100.0

Figure 5.15

By the answering of this specific question, 59.1% patients said we did not get treated due to
other reason, 23.6% patient said they did not get treated due to expensive treatment, while 17.3%
said due to our careless.

30
Can you get hepatitis by getting a blood transfusion from an infected person?

Table 5.16
can you get hepatitis C by getting a blood transfusion from an infected persons
Frequency Percent Valid Percent Cumulative
Percent
True 92 83.6 83.6 83.6
False 2 1.8 1.8 85.5
Valid
Don't know 16 14.5 14.5 100.0

Total 110 100.0 100.0

Figure 5.16

83.6% patients said they get hepatitis C by getting blood transfusion from infected person while
14.5% said they don’t know how they get effected.

31
Can you get hepatitis C by shaking hand with infected persons?

Table 5.17
can you get hepatitis C by shaking hand with infected person
Frequency Percent Valid Percent Cumulative Percent

True 8 7.3 7.3 7.3

False 41 37.3 37.6 45.0
Don't know 60 54.5 55.0 100.0

Total 109 99.1 100.0

System 1 .9

Total 110 100.0

Figure 5.17

Well, 54.5% of patients don’t know did they get Hepatitis C by shaking hand with infected
person, while 37.6% patient did not agree with this statement.

32
Can you get hepatitis C by contacting with needle or sharp instruments?

Table 5.18
can you get hepatitis C by contacting with needle or sharp instruments
Frequency Percent Valid Percent Cumulative
Percent
True 70 63.6 63.6 63.6
False 11 10.0 10.0 73.6
Valid
Don't know 29 26.4 26.4 100.0

Total 110 100.0 100.0

Figure 5.18

Out of 100% of patients, 63.6% patients agree they get infection by contacting with sharp
needles, while 26.4% said don’t know.

33
Can you get hepatitis C by working with someone who has hepatitis C?

Table 5.19
can you get hepatitis C by working with someone who has hepatitis C
Frequency Percent Valid Percent Cumulative
Percent
True 15 13.6 13.8 13.8
False 38 34.5 34.9 48.6
Don't know 56 50.9 51.4 100.0

Total 109 99.1 100.0

Missing System 1 .9

Total 110 100.0

Figure 5.19

51.4% patients selected the option “don’t know” while 34.9% patients said we did not get
infected by working with someone who has hepatitis C.

34
5.2 DISCUSSION

The study was conducted in DHQ hospital Narowal, Punjab on the basis of Prevalence of
hepatitis C infection in adults. Total 110 data was collected randomly. It was a cross sectional
study. Question was asked from the patient directly and then analysed through SPSS.

In this study overall 110 participants, 62 are female and 48 are male out of which 56.4% are
female and male are 43.6% of total population. Another study carried out in Punjab suggests that
49.5%patients were male while 50.5% were female patients with age group of 36-40years with
12.23% and lowest is found in age group > 15 years with 0.31%. Prevalence of Hepatitis C in
age group of < 15 years in 0.31%, in 15-20 years is 2.63%, in 21-25 years is 6.49%, in 26-30
years is 10.63%, in 31-35 years is 10.48%, in 36-40 years is 12.32% in 41-45 years is 7.23% in
46-50 years is 9.13%, in 51-55 years is 1.90%, in 56-60 years is 0.83% and in >60 years is
0.58% (37), from my study we find that the patients whose age are between 31-45 year are
mostly effected from Hepatitis C virus.

In our study we find that 83.6% of patient gets hepatitis C by blood transfusion which is more
than other cause while10% says they get hepatitis C by injecting un-prescribed drugs and 63.6%
of total patient says that get through infected sharp needles and instruments, while the other
study shows the prevalence of HCV infection in Pakistan due to different risk factors ranging
from 27% because of multiple use of needles to 2% due to needle stick injuries and 8% due to
blood transfusion 22% from medical/dental procedure. Furthermore, it has been reported that
almost 50% of the patients receive unnecessary therapeutic injections without any safe medical
practices including reuse of syringes.(38)

According to WHO, 95% of people infected with HCV can be cured within 2–3 months with
highly effective direct-acting antiviral (DAA) drugs.6 Licensed treatments for HCV infection in
Pakistan include Pegylated and standard interferon, ribavirin, and DAA drugs (e.g. sofosbuvir).
The government has introduced new DAA drugs that could cure up to 90% of the infected
population and made generic sofosbuvir available at US$15 for 400 mg—the lowest price
worldwide.4 As a result, the number of people receiving HCV treatment has more than doubled.

35
In our study we find that 42.7% patient says doctor tell us about these medication and 34.5%
says doctor did not tell them about certain medication. About 73.6% of total patient did not get
treated because, 23.6% said due to expensive treatment, 17.3% said due to his/her own careless
and 59.1% said due to other reason.

36
Chapter 6
Conclusion and Recommendation
6.1 Conclusion
After checking all the question about prevalence of Hepatitis C and certain other questions we
concluded that the population which have high ratio of Hepatitis C are females with a ratio of
56.4% across the DHQ Hospital Narowal, Punjab. The most effected age is 31-45Yrs with a ratio
of 42.7% which is very high. About 92.7% patient already know about hepatitis C before and
34.5% patient did their blood test to check how their liver are damage and how much working
yet. After collecting data we know that 48.2% patients face hepatitis C for few years. Only 0.9%
patients did their liver biopsy to check how much their liver damaged. 80.9% of patients did their
Hepatitis C test due to other reason while 13.6% did their test before blood donation. Nearly
80.9% of patient said the result is positive while 6.4% refused.
Our study shows 40% of patient received Hepatitis vaccine before while 52.7% said they didn’t.
Big way of transmission of disease is blood transfusion from infected person which is 92% of
total patient of our study. Out of 100% of patients 13.6% said they were treated with interferon
and ribavirin drugs, while 73.6% said they didn’t treated from these medication. About 70% of
patients said sharp instrument and needles also cause hepatitis C while 26.4% said we don’t
know.

6.2 RECOMMENDATIONS
 Don’t share personal toiletry items like toothbrush, razor or towel etc.
 Avoid Alcohol, control your weight, get some exercise and eat a healthy diet. Alcohol
and obesity can make hepatitis C harder to treat.
 Don’t sex with multiple partners if you have a multiple sexual partners, practice safe sex.
 Use needle safety precautions id you use intravenous drugs, don’t share needles.
 Do proper vaccination
 Avoid direct exposure to blood or blood products.
 Avoid yourself from sharp instruments and needles
 Follow preventive methods during work
 Eat well and fresh fruits and vegetables

37
REFERANCES

1. Judith Marcin M. Hepatitis [Internet]. 2015. Available from:

https://www.healthline.com/health/hepatitis

2. Charles Patrick Davis, MD P, Jay W. Marks M. Hepatitis (Viral Hepatitis, A, B, C, D, E,

G) [Internet]. Available from: https://www.medicinenet.com/viral_hepatitis/article.htm

3. Ashwani Singal, MD, MS F. Hepatitis C Infection (Hep C): Causes, How It’s Spread, and
Treatment Guidelines for the Cure [Internet]. Available from:
https://www.medicinenet.com/hepatitis_c/article.htm#hepatitis_c_infection_hcv_definitio
n_and_facts

4. AH1 Y, Marquez-Azalgara V Yoshida EM. Hepatitis C (chronic). [Internet]. 2015.

Available from: https://www.ncbi.nlm.nih.gov/pubmed/26107930

5. Zhang S, Xu X. Dynamic analysis and optimal control for a model of hepatitis C with
treatment. Commun Nonlinear Sci Numer Simul [Internet]. 2017;46:14–25. Available
from: http://dx.doi.org/10.1016/j.cnsns.2016.10.017

6. Teles SA, Gir E, Martins RMB, dos Santos Carneiro MA, de Matos MA, Caetano KAA.
Emergent predictors of hepatitis C infection among non-injection drug users. J Infect
Public Health. 2017;(January).

7. Chowdhury A, Santra A, Chaudhuri S, Dhali GK, Chaudhuri S, Maity SG, et al. Hepatitis
C virus infection in the general population: A community-based study in West Bengal,
India. Hepatology. 2003;37(4):802–9.

8. Bragg DA, Crowl A, Manlove E. Hepatitis C: A New Era. Prim Care - Clin Off Pract.
2017;44(4):631–42.

9. Afzali M, Mirzaei M. Epidemiology of hepatitis C in Islamic Republic of Iran. Asian

Pacific J Trop Dis [Internet]. 2016;6(12):969–72. Available from:
http://dx.doi.org/10.1016/S2222-1808(16)61166-0

10. Jamil MS, Ali H, Shaheen R, Basit A. Prevalence, knowledge and awareness of hepatitis
C among residents of three Union Councils in Mansehra. J Ayub Med Coll Abbottabad

38
 [Internet]. 2010;22(3):192–6. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/22338454

11. Ali SA, Donahue RMJ, Qureshi H, Vermund SH. Hepatitis B and hepatitis C in Pakistan:
prevalence and risk factors. Int J Infect Dis. 2009;13(1):9–19.

12. Nguyen LH, Nguyen MH. Systematic review: Asian patients with chronic hepatitis C
infection. Aliment Pharmacol Ther. 2013;37(10):921–36.

13. Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and

genotype distribution of the hepatitis C virus infection. J Hepatol [Internet].
2014;61(1):S45–57. Available from: http://dx.doi.org/10.1016/j.jhep.2014.07.027

14. anonymous. Hepatitis C [Internet]. Available from:

http://www.hepatitiscentral.com/hepatitis-c/

15. Attaullah S, Khan S, Ali I. Hepatitis C virus genotypes in Pakistan: A systemic review.
Virol J [Internet]. 2011;8(1):433. Available from:
http://www.virologyj.com/content/8/1/433

16. Hu XB, Yue QH, Zhang XQ, Xu XQ, Wen Y, Chen YZ, et al. Hepatitis B virus genotypes
and evolutionary profiles from blood donors from the northwest region of China. Virol J
[Internet]. 2009;6. Available from: https://doi.org/10.1186/1743-422X-6-199

17. FNP KD. Everything you need to know about hepatitis C [Internet]. 2017. Available from:
https://www.medicalnewstoday.com/articles/294705.php

18. anonymous. C?, What are the Signs & Symptoms of Hepatitis [Internet]. Available from:
http://hepc.liverfoundation.org/diagnosis/symptoms-of-hep-c/

19. Hoofnagle JH. Hepatitis C: the clinical spectrum of disease. Hepatology [Internet].
1997;26(3 Suppl 1):15S–20S. Available from:
http://onlinelibrary.wiley.com/doi/10.1002/hep.510260703/epdf

20. T1 P, V R, J M, M M, Z G, S Z, et al. Effect of treatment with peginterferon or interferon

alfa-2b and ribavirin on steatosis in patients infected with hepatitis C. Hepatology
[Internet]. 2003; Available from: https://www.ncbi.nlm.nih.gov/pubmed/12829989

39
21. Koziel MJ, Dudley D, Wong JT, Dienstag J, Houghton M, Koziel MJ, et al. Intrahepatic
cytotoxic T lymphocytes specific for hepatitis C virus in persons with chronic hepatitis .
Ralston and B D Walker Information about subscribing to The Journal of Immunology is
online at : VIRUS IN PERSONS WITH CHRONIC HEPATITIS ’. 2018;

22. Giannini C, Bréchot C. Hepatitis C virus biology. Cell Death Differ [Internet].
2003;10(S1):S27–38. Available from: http://www.nature.com/articles/4401121

23. Lindenbach BD, Rice CM. Unravelling hepatitis C virus replication from genome to
function. Nature. 2005;436(7053):933–8.

24. Conte D, Fraquelli M, Prati D, Colucci a, Minola E. Prevalence and clinical course of
chronic hepatitis C virus (HCV) infection and rate of HCV vertical transmission in a
cohort of 15,250 pregnant women. Hepatology. 2000;31(3):751–5.

25. anonymous. Hepatitis C [Internet]. 2017. Available from: http://www.who.int/en/news-

room/fact-sheets/detail/hepatitis-c

26. S1 U, H C, W M, H V, C. V. Evaluation of third-generation screening and confirmatory

assays for HCV antibodies. Available from:
https://www.ncbi.nlm.nih.gov/pubmed/7514324

27. Saadeh S, Cammell G, Carey WD, Younossi Z, Barnes D, Easley K. The role of liver
biopsy in chronic hepatitis C. Hepatology. 2001;33(1):196–200.

28. hepatitis-c diagnosis [Internet]. Available from: https://www.nhs.uk/conditions/hepatitis-

c/diagnosis/

29. WHO. Prevention & Control of Viral Hepatitis Infection: [Internet]. 2012. Available from:
http://apps.who.int/iris/bitstream/handle/10665/130012/WHO_HSE_PED_HIP_GHP_201
2.1_eng.pdf;jsessionid=E01497037D0EC10B81084DE4BADC42E4?sequence=1

30. Bari a, Akhtar S, Rahbar MH, Luby SP. Risk factors for hepatitis C virus infection in
male adults in Rawalpindi-Islamabad, Pakistan. Trop Med Int Heal [Internet].
2001;6(9):732–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11555441

31. Ghias M, Pervaiz MK. Identification of Epidemiological Risk Factors for Hepatitis C in

40
 Punjab, Pakistan. J Ayub Med Coll Abbottabad. 2009;21(2):156–61.

32. Yeung C-Y. Vertical transmission of hepatitis C virus: Current knowledge and
perspectives. World J Hepatol [Internet]. 2014;6(9):643. Available from:
http://www.wjgnet.com/1948-5182/full/v6/i9/643.htm

33. Z. M, M. J, R.A. K, S. UR. Screening for hepatitis B & C: A routine preoperative

investigation? Pakistan J Med Sci [Internet]. 2005;21(4):455–9. Available from:
http://www.pjms.com.pk/issues/octdec05/pdf/hep_b_c.pdf%5Cnhttp://ovidsp.ovid.com/
ovidweb.cgi?T=JS&PAGE=reference&D=emed7&NEWS=N&AN=2006114970

34. Shaikh FH, Ali Abro H, Ali Chhutto M, Abbasi PA, Shaikh AW, Ali Buriro S. Hepatitis
C: frequency and risk factors associated with sero-positivity among adults in Larkana
City. J Ayub Med Coll Abbottabad. 2009;21(April 2006):107–9.

35. Sievert W, Altraif I, Razavi HA, Abdo A, Ahmed EA, Alomair A, et al. A systematic
review of hepatitis C virus epidemiology in Asia, Australia and Egypt. Liver Int.
2011;31(SUPPL. 2):61–80.

36. Lanini S, Easterbrook PJ, Zumla A, Ippolito G. Hepatitis C: global epidemiology and
strategies for control. Clin Microbiol Infect [Internet]. 2016;22(10):833–8. Available
from: http://dx.doi.org/10.1016/j.cmi.2016.07.035

37. Ashraf F, Rasheed A, Ullah S, Shaukat M. Hcv in Punjab; Zonal Molecular Distribution.
Prof Med J [Internet]. 2015;20(10):1268–72. Available from:
http://www.theprofesional.com/article/vol-22-no-10/prof-2946.pdf

38. Mahmood H. Risk Factors of Hepatitis C in Pakistan. Gastroenterol Hepatol Open Access
[Internet]. 2017;7(6). Available from: http://medcraveonline.com/GHOA/GHOA-07-
00259.php

41
 Questionnaire
PREVALENCE OF HEPATITIS C IN ADULTS PRESENTING IN DHQ HOSPITAL
NAROWAL, PUNJAB.

Researcher: Syed Ali Abdullah

Syed Hammad Ali Hamdani

Name: ________ Gender: _______ Age: _______

1-There are many types of hepatitis. Had you heard of hepatitis C before?
1. Yes 2. No 3. Don't know

2-Did you see a doctor or other health professional about your hepatitis C test result?
1. Yes. 2. No 3.Don't know

3-When you saw a doctor or other health professional about your hepatitis C test results, did you
have other blood tests to check how your liver is working?
1. Yes. 2. No 3.Don't know

4-For about how long have you known that hepatitis C? Would you say…?
1. Few Days Ago 2. Few Months Ago 3. Few Years Ago

5-Did you have a liver biopsy (procedure to get a small piece of your liver through a needle)?
1. Yes. 2. No 3. Don't know

6-Why were you first tested for hepatitis C? Was it because:

1.You donated blood 2. Other reason 3. Jaundice

7- The result was positive when you had done the test ?
1. Yes. 2. No 3. Don't know
8- Did you ever received hepatitis B vaccine?
1. Yes. 2. No 3. Don't know

9-Did you received blood transfusion ever?

1. Yes. 2. No 3. Don't know

10.Did you ever injected drugs not prescribed by a doctor even if only once or a few times?
1. Yes. 2. No 3. Don't know

42
Now I’m going to ask you some questions about what you have done, since finding out that
you have hepatitis C.
11-Did your doctor or health care professional tells you that your hepatitis C should be treated
with medication such as Interferon, Sofosbuvir and Ribavirin?
1. Yes. 2. No 3. Don't know

12-Did you get treated with these medicines?

1. Yes. 2. No 3.Don't know

13-Why did you not get treated? Was it because...

1-yours careless 2-Expensive treatment 3-Other reason
We would like to know what you have learned about hepatitis C. Please tell me if you believe the
following statements are true or false, or if you don’t know whether they are true or false

14-You can get hepatitis C by getting a blood transfusion from an infected donor.
1. True 2. False 3. Don't know

15- You can get hepatitis C by being stuck with a needle or sharp instrument that has 1.
True 2. False 3. Don't know

16- You can get hepatitis C by working with someone who has hepatitis C.
1. True 2. False 3. Don't know

Patient Name ______________ Patient Signature__________________

Thank you for your precious time. We appreciate your participation.

43